Canada Health Infoway (Infoway) is hosting the 2018 Infoway Partnership Conference: Driving Access to Care, on Nov.13-14, 2018 in Montreal. The conference takes place during Digital Health Week (Nov. 12-18, 2018), which celebrates the difference digital health is making in the lives of Canadians. Conference participants will engage in a national conversation about providing safer medication practices, empowering Canadians with access to their health information and digital health services, and sharing and exchanging knowledge about clinical interoperability, privacy, change management and more.

Gevity recently spoke to Lynne Zucker, Infoway’s Executive Vice President, ACCESS  Health, about the 2018 Infoway Partnership Conference, Digital Health Week 2018 and the current state of digital health in Canada. Gevity has consulted for and partnered with Infoway in various capacities over the past decade, providing services to help develop and maintain various pan-Canadian Electronic Health Record standards and project management and stakeholder engagement services. Gevity and Infoway employees have participated together in numerous Canadian and international committees and collaborated on events such as FHIR North.

Gevity: The Nov. 14 keynote of the Partnership conference is about bringing Canada’s healthcare system into the 21st century. Where are we at right now? How much progress have we made at the system level in the implementation of digital health technology? Is there a lot of regional variance?

Lynne Zucker: At the Canada-wide level, we are lagging behind our peer countries when it comes to a bucket we call “access to care.” That bucket includes things like online access to health information and the ability to email a clinician. We’ve made lots of progress on getting the infrastructure in place and putting electronic medical record systems (EMRs) in the hands of physicians – 85 per cent of primary care doctors in Canada now have an EMR – but less progress on other aspects of digital health, such as e-prescribing and the ability to communicate with clinicians via email. There are many studies that show lots of economic benefits associated with the implementation of digital health technology, including improved productivity, but we’ve fallen short overall on our ability to connect the dots to enable a truly modernized health system.

Gevity: To what do you attribute that “last mile” lag?

Lynne Zucker: Canada’s health system is  very fragmented, and we suffer from “pilotitis.” By that, I’m referring to the fact that we are great at implementing regional projects, but our system as constituted does not support scaling of innovation, so it’s hard for private sector innovators to crack the system and scale their products. There are also a lot of competing interests so it’s hard to get everyone’s interests aligned. Some of the challenges are clinician payment models, privacy legislation governing technology, and standards and interoperability. All these things add up and contribute to the challenges we face in catching up and scaling up.

Gevity:  What has contributed the most to advancing digital health over the last year? Is it technology, policy, funding or anything else?

Lynne Zucker: I think we are advancing, but sometimes it’s hard to see something when you’re in the middle of it. I’d say consumer demand is the key driver behind the push for digital health. My favourite story about that is that the CEO of a children’s hospital once told me the parents of one of the hospital’s patients, both of whom were young adults, couldn’t believe it when they were given an appointment card. They couldn’t believe they couldn’t just communicate digitally, so I think that eventually, consumer demand will force the system to catch up.

Gevity: Tell us a bit more about the “pilotitis” issue.

Lynne Zucker: There is a growing understanding of the need to move from pilots to models of scale, but there is a lot of uphill pushing required. The work we’ve done with PrescribeIT™ highlights that less than one per cent of prescriptions move electronically in Canada, while in the rest of the developed world, most do.

The issue is that some things need national scale to be practical to sustain, and my sense is that people are beginning to understand that, but we still need to overcome the “not invented here” attitude that contributes to rejection of ideas or systems developed in other jurisdictions. This has been a long-term challenge. It’s not that people don’t acknowledge the need, but when you don’t have everything aligned, you end up having to reinvent the wheel, so to speak, in each place. Some of the transformations required are time-consuming and challenging to execute, there are competing interests and the economies of scale are not in place yet, but that’s what Infoway is working on now.

Gevity: Do you have any predictions for the state of digital health in Canada in 10 years from now? What will that picture depend on?

Lynne Zucker: Ten years from now we won’t need to talk about “digital health” because it will all be integrated as part of the overall healthcare system. Our goal is to use the citizen lever to drive demand and push forward the expectation of a healthcare system that provides safe, high-quality care with lower costs and enhanced provider performance. We will use digital technology and tools to resolve the underlying challenges that have kept us from moving forward. I think that’s very doable and we’re trying to line up the “coalition of the willing” to make that happen.

Gevity: How aware would you say Canadians are of the availability of digital health tools such as online health records, e-prescriptions and virtual consultations, and of the benefits of these digital health technologies? How do you measure that?

Lynne Zucker: Every year since 2014, Infoway has conducted surveys to gauge Canadians’ awareness of and interest in digital health, so we have lots of data on that. In our 2018 Connecting Patients for Better Health report, the list of what patients and citizens are looking for has not changed a lot from responses in previous reports. They are looking for convenience and the ability to manage their care, communicate with their care provider and feel like a partner. We also work with the provinces and territories on other research studies and build national economic models and projections, and we engage a lot of patients in our work, so we have our ear pretty close to the ground.

Gevity: Infoway is doing a lot of work to educate Canadians and debunk the myths or misunderstandings about digital health, but what are the biggest challenges you face in building awareness and promoting adoption by patients?

Lynne Zucker: Our data show if you make it available, adoption is not an issue; there is fairly quick uptake. Most people just assume that being able to manage their healthcare digitally is either coming or in the works because technology is such a major part of our lives in so many other spheres. As a principle, we’ve found that if you can give people access that is free of commercial interest and secure, and you can reassure them about data usage practices, the general market is ready.

Gevity: The upcoming conference is about partnerships. Infoway works with a broad range of provincial and territorial governments and a number of professional, academic, private sector and advocacy organizations. What is the role of partnership in broadening the adoption of digital health? Are there any types of partnerships you have not yet formed that you think would advance digital health? Do you see partnerships playing an even bigger role in the future?

Lynne Zucker: In our distributed health system, partnerships are the only way to get anything done! As part of our new ACCESS Health program, we’re launching the ACCESS Alliance to bring innovative digital health companies together, provide them with tools that will facilitate access to this market and help them to work together and provide innovative ways of giving Canadians access to care. The private sector has not been able to provide those solutions in a scaled-up way because everyone is working on pilot projects. The PrescribeIT™  initiative is an interesting example of partnership, though, because a prescription goes from a prescriber, who is paid by the government, to a retail pharmacy, which is part of the private sector. We’re trying to build a scaled e-transmission service, but we need public trust for that to happen. We’ll be discussing lots of partnerships we are involved in at the conference, including one with the Cowichan Tribes in B.C., and another with Kids Help Phone. We’re looking to do more on a national scale while working within the framework of provincially managed healthcare systems.

Gevity: What do you see as the most exciting innovations that are emerging now that will have a major impact on digital health over the next five years or so?

Lynne Zucker: The one I’m most excited about is what we call citizen identity, which is a single, easy-to-use system for verifying the identity of those requesting access to digital health records and services. If we want to connect citizens to their healthcare system and their information, we need a high level of trust that they are who they say they are and that they are the ones who are asking for their information. There is lots of work going on across the country to resolve the challenges associated with enabling citizens to identify and authenticate themselves and once that – a pan-Canadian trust framework – is developed, that can unlock a lot of other innovations in the healthcare sector. Developing that citizen identity system will require both policy and technology work but it’s a key building block to ensuring citizens have digital access. I’m also excited about artificial intelligence (AI). It’s going to show up everywhere from triage to clinical decision support and the delivery of therapy.